Dr. Hazem A., Dr. El Deeb W., Dr. El Morsi A., Dr. Al Attar A., Dr. Amin A., Dr. Naguib M., Dr. Abou Shoer M

1. Dr. Hazem A., Dr. El Deeb W., Dr. El Morsi A., Dr. Al Attar A.,
Dr. Amin A., Dr. Naguib M., Dr. Abou Shoer M.

2. Did you know that uterine myomas are the
commonest pelvic tumours?
• It is found in at least 20% of females over the age
of 30.
• The incidence increase with age.
• Fibroids can be identified in 50% of nulliparous
women at the age of 50 years.

4. • Excessive uterine bleeding
• Pelvic pressure and pain
• Recurrent pregnancy losses
• Infertility
• The last two symptoms are particularly
related to submucous or intramural fibroids
distorting the uterine cavity.

5. • Ultrasonography: Site, size and number of
fibroids.
• Contrast ultrasonography: Determines
endometrial distorsion by submucous fibroids.
• Hystogram or Hystroscopy: For submucous
fibroids.
• Intravenous Urography: To look for ureteral
obstruction with large broad ligament myomas.
• MRI: May be needed with very large fibroids, to
differentiate between adenomyosis and fibroids.

6. Laparoscopic myomectomy has provided a minimally invasive
alternative to laparatomy for subserous and intramural
myomas.
Recently, there is an increasing trend for minimal
invasive surgery (MIS) for treatment of uterine
myomas.

7. randomized trial was performed
on 80 women, 22 to 45 years old, undergoing
myomectomy.
• Patients were randomized to have laparoscopy
(n = 40) or laparatomy (n = 40). The intensity of
pain was assessed by a visual analog
postoperatively
A prospective, randomized trial to evaluate
benefits in early outcome in Alex Sydney Keil
hospital

8. • The intensity of postoperative pain was lower
after laparoscopy than after laparatomy.
• A higher proportion of patients was analgesic free
on day 2, discharged from hospital by day
1inlaparscopy and day 2in laparatomy, and feeling
fully recuperated on day 15 in laparatomy and on
day 7 in laparoscopy.
• Decreased incidence of ileus and thrombo-embolic
phenomenon.

9. RESULTS
Laparoscopy Laparotomy
Intra-operative
time (min.)
93.0 + 22 67.0 + 16 P <0.02
Blood loss during
operation
“Decline in Hb”
Less
1.1 g/dL
More
2.2 g/dL
P <0.001
Time of
hospitalization
1 Day 2 Days P <0.001
Post-operative
pain
“Day 2 analgesia
free”
85% 15% P <0.001
Pregnancy rate
per cycle
6.5% 3.9% P = 0.04

10. Intraoperative laparatomy laparoscopy
Haemdynamics + ++
Ventilatory 0 ++
CO2 0 ++
Controlled ventilation + ++
Position + ++
Anesthesia requirement = =
Stress response ++ ++
Surgical Trauma ++ +
Postoperative
Pain ++ +
Pulmonary dysfunction ++ +
Metabolic & acute phase reaction ++ +
Fatigue ++ +
Recovery ++ +
Fasting ++ +
Hospital stay ++ +
Morbidity & Mortality + +
+ Problem
= No diference
0 Not a factor

11. • Any medical condition that is worsened by
abdominal distention and/or trendelenberg
position for a prolonged period
• Diffuse leiomyomata
• More than 3 myomas = or >5cm
• Uterine size >16 weeks gestation
• Myoma >15 cm in diameter

13. • It requires a greater degree of skill.
• Certain myomas (lower posterior) may be
technically difficult to handle.
• There is concern regarding operation time as
closure of the uterine incision can be time
consuming.
• The flexibility in planning the surgical
technique and removal of myoma from
abdominal cavity is often limited.

14. The automatic morcellator provides significant
saving in operation time and is a cost
effective application of a new technology from
this point of view .

18. • Intramural haematoma at the incision point.
• Tissue necrosis due to thermal damage leading
to defective scar formation.
• Incorrect approximation of incision edges
leading to healing by secondary intention .

19. Uterine rupture after laparoscopic myomectomy
can be avoided, by avoiding excessive thermal
damage and adequate uterine repair using
multiple layer suturing technique.
•

20. • Shorter hospitalization time.
• Faster post operative recovery.
• Decreased incidence of post operative pain
• Decreased incidence of ileus and thrombo-
embolic phenomenon.
• Less post-myomectomy adhesion formation
• Better reproductive outcome.

21. • Atraumatic manipulation.
• Fine instruments.
• Thorough washing.
• Less intraperitonial contamination and has
less effect on the equilibrium of peritoneum.

22. • Laparoscopic myomectomy is a recent
advance in the field of gynecological surgery.
• It requires proper patient selection,meticulous
technique & experience in laparoscopic
suturing skills.
• If strict criteria are used ,laparoscopic
myomectomy is as effective as abdominal
myomectomy, and in certain situations, it has
more advantages than abdominal
myomectomy .

23. Thank you